A missed abortion is a type of pregnancy loss, also known as a missed miscarriage or a spontaneous abortion. It occurs when pregnancy has stopped developing and, thus, is no longer viable, but it has not yet been expelled from the uterus.
In the case of a missed abortion, you have three options: waiting, using medication like misoprostol (Cytotec) to help expel the uterine contents, or having a manual vacuum aspiration procedure with a trained clinician. All three options are reasonable, and it is a personal choice for each individual. Management of a missed abortion with misoprostol will be discussed here.
How do you know you have had a missed abortion?
A missed abortion is often diagnosed by a clinician during a routine evaluation when there is a nonviable pregnancy seen on an ultrasound. Oftentimes, there will not be any symptoms, but the disappearance of pregnancy symptoms that were previously present can be one common indicator. Sometimes, this can be accompanied by a brown discharge or even light bleeding.
If you suspect a missed abortion, or if you experience symptoms of pregnancy loss (vaginal bleeding with abdominal cramping), it is recommended you see a clinician for an evaluation.
What is misoprostol?
Misoprostol is a medication that can be used to prevent stomach ulcers because it decreases the production of acid within the stomach. It is often given to people who are using routine NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen. In these cases, it protects the stomach from developing ulcers. It is also commonly used for the induction of labor, medication abortions, and pregnancy loss as detailed below.
Misoprostol for a missed abortion
Although labeled as a stomach ulcer medication, it is commonly used for cases of pregnancy loss, including missed abortions. This is often diagnosed when a pregnancy is determined to no longer be growing, often via ultrasound. In these cases, bleeding or cramping has not yet started.
Because it is used for stomach ulcers, misoprostol is a relatively common medication. In some places around the world it is available to purchase off the shelf, while in other areas you may require a prescription.
A single dose of misoprostol (4 200mcg tablets, or 800mcg in total) for a missed abortion will allow approximately two-thirds of people to successfully complete expulsion. Some people may require additional doses of misoprostol for the process to be complete. Read about the full protocol here.
According to the World Health Organization (WHO), misoprostol may be used via any route (dissolved in the mouth, under the tongue, or directly in the vagina) to manage a missed abortion. Each individual must choose the best route for that person’s specific situation. However, it is advised to only use the oral route in countries where abortion is restricted as it is untraceable, whereas, remnants of the pills could be found in the vagina for a few days afterwards.
How it works
If you are planning to use misoprostol to manage a missed abortion, it will lead to bleeding and cramping similarly to what one would experience with a miscarriage. If you are able to obtain this medication on your own, it is safe to use it to manage the missed abortion. In some cases, it will be prescribed by a clinician to help expel the contents from the uterus.
Wear a night-capacity pad when taking your medication to make sure you are prepared for the bleeding that the medication can cause. Symptoms such as vaginal bleeding and cramping from misoprostol usually start within one to four hours after taking the medication.
Bleeding experienced from misoprostol for management of a missed abortion may be similar to your period, but it might be more than you’re used to. Bleeding will often last for one to two weeks after a missed abortion, but can last longer too. There might be times when you have sudden starts and stops in your menstrual cycle, similar to spotting. Cramping is usually the most intense within the first 24 hours after using misoprostol but can occur on and off for several days too. Click here for more details on what to expect when taking abortion pills.
Risks of using medication to manage a missed abortion
The risks of using misoprostol to manage a missed abortion are similar to the risks experienced by someone having a natural miscarriage. There is a risk of heavy bleeding (hemorrhage), a small risk of infection, and a risk that it will be incomplete and require manual evacuation.
When to get emergency assistance
If you have any of these side effects after taking misoprostol, consult your clinician right away:
- fever and chills that last more than 24 hours after taking misoprostol;
- a foul vaginal discharge or odor;
- heavy bleeding that soaks two menstruation pads or more each hour for two hours straight (four full pads within two hours); and/or
- dizziness, lightheadedness, or feeling faint, which could be a sign of a low blood count.
“Patients Taking Misoprostol Misunderstood: How to Manage Patients with Miscarriages.” Inside Patient Care, 2015, insidepatientcare.com/issues/2015/may-2015-vol-3-no-5/186-patients-taking-misoprostol-misunderstood-how-to-manage-patients-with-miscarriages. Accessed November 2022.
“Misoprostol Medication for Managing Miscarriage.” VeryWellFamily, 2022, www.verywellfamily.com/misoprostol-or-cytotec-for-managing-miscarria-2371457#:~:text=Misoprostol%20is%20labeled%20as%20an%20ulcer%20medication%20but,use%20by%20the%20Food%20and%20Drug%20Administration%20%28FDA%29. Accessed November 2022.